[lastrada222]

I have a question on the appropriate use of O2 and the amt via nasal canulla. Post -op knee replacement pt. 3 days with hypotension, Pt is lethargic does not have any pain, has been ambulated by pt. and has been out of bed to chair. I am questioning the amount of O2 That was used non this pt. Was told that it can be turned up to 6 without any ill-effects. Pt. also then was placed on a re-breather. Blood gases were not gotten before this was done. I was under the impression from all that I have been taught that O2 at 2-3 liters is all a person should be given otherwise toxicity an occur. Blood gasses should be obtained and notification of the MD for further instructions. As far as I am concerned it wasn't clear what was wrong with this pt. especially in the absence of pain and low BP. I would appreciate your insight.

[Michigan RN]

IF that patient is lethargic and on 6 liters of oxygen I would have strongly suggested to the doctor to get a set of blood gases. Just seems like there is an oxygenation issue going on there if the patient had to then be placed on a rebreather

[sharrie]

I would usually not put a nasal cannula higher than 4 maybe 5 litres max as it can give the patient a headache. If it needs a higher flow then it is standard protocol where I work to switch over to a mask.

As far as high flow O2 if I was concerned about a patients condition and they with signs such as hypotension, tachycardia, altered mental status I would put high flow on and get a medical review, the O2 can always be turned down and if your patient is becoming unwell then increasing O2 should be one of the first things that you think about, this works within the guidence of managment of the seriously ill patient, in the UK this is taught on courses such as Acute Life- threatening events managmment and treatment (ALERT) and as part of the advanced life support courses.

I would be more concerned if high flow O2 had not been used in a potentially unwell patient

[EricEnfermero]

Originally Posted by sharrie

I would usually not put a nasal cannula higher than 4 maybe 5 litres max as it can give the patient a headache. If it needs a higher flow then it is standard protocol where I work to switch over to a mask.

As far as high flow O2 if I was concerned about a patients condition and they with signs such as hypotension, tachycardia, altered mental status I would put high flow on and get a medical review, the O2 can always be turned down and if your patient is becoming unwell then increasing O2 should be one of the first things that you think about, this works within the guidence of managment of the seriously ill patient, in the UK this is taught on courses such as Acute Life- threatening events managmment and treatment (ALERT) and as part of the advanced life support courses.

I would be more concerned if high flow O2 had not been used in a potentially unwell patient

The biggest issue with 6 LPM via NC is that it gets pretty uncomfy.

[lastrada222]

thank you all for your reply. I was not concerned with having o2 applied. I just didn't think 6 liters was correct. I was taught that 02 is a drug and should be used cautiously especially in the case of any respiratory illness and that 2-3 liters was more appropriate until the MD ordered different treatment or meds

[lastrada222]

follow-up on use of 02 . This discussion of how and how much in a hypotensive post- op has raised many replies and answers that have propelled this discussion into an investigation by my students. I am a clinical instructor for a RN program and this has encouraged discussion and a seeking out of protocols and commonalities that would guide the actions of applying 02 until the MD. arrives or gives further direction. It should be interesting to hear their individual reports as they have verbally recieved so many different answers from EMT'S and floor nurses that they have questioned. Any further thoughts on this subject is appreciated. I will post the results of their inquiry for all to view